Tutorial title - Hepatobiliary System - Liver Failure
9 important questions on Tutorial title - Hepatobiliary System - Liver Failure
What are the features of acute hepatitis or liver dysfunction?
- Acute phase response: jaundice, RUQ pain, hepatomegaly.
- Bleed disorder features: easy bruising, DIC.
- Portal hypertension.
- Features of encephalopathy: irritability, vomiting, headache, papilledema, Cushing's triad - bradycardia, widened pulse pressure, irregular breathing.
- Rigidity, hyperreflexia, asterixis.
What is liver failure and what are its key characteristics?
- Inability to develop clotting factors
- Hepatic encephalopathy
- Bleeding pattern in hepatic coagulopathy presents as Vitamin K related coagulopathy
- Administration of Vitamin K will improve coagulation time
- No clotting factors are present
Describe the biochemical features related to liver dysfunction.
- Metabolic acidosis with lactate acid buildup.
- Albumin levels decrease.
- Alpha-fetoprotein levels increase.
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How is liver failure classified based on time frame and etiology?
- Acute liver failure: Less than 26 weeks, within 6 months
- Chronic liver failure/disease: More than 26 weeks
What are the chronic features of liver dysfunction?
- All features of acute liver failure.
- Edema (ascites) leading to spontaneous bacterial peritonitis.
- Palmar erythema, spider angiomas, finger clubbing.
- Terry's nail (leukonychia), half-and-half nail (CKD).
- Dupuytren's contracture.
What are the differences between acute liver failure and chronic liver disease?
- Presence of coagulopathy and encephalopathy without signs of chronicity
- Causes include Hepatitis B, autoimmune hepatitis, and Wilson's disease
- Fibrosis
- Low albumin levels, possibly due to malnutrition
What is the Child Pugh Score and its classification?
- Presence of hepatic encephalopathy (grades).
- Coagulopathy.
- Degree of ascites.
- Rate of decline of albumin levels.
- Quantity of bilirubin.
- Class A: 5-6 (well compensated).
- Class B: 7-9 (partial decompensated).
- Class C: >10 (decompensated with aggressive treatment).
What are the types of acute liver disease and their characteristics?
- Hyperacute: Jaundice to encephalopathy within 1 week
- Acute: Jaundice to encephalopathy in 8 days to 4 weeks
- Subacute: Jaundice to encephalopathy in more than 4 weeks to 26 weeks
What are the causes of acute liver failure?
- Hepatitis (infective)
- Alcohol (chronic causes usually)
- Drug toxicity
- Ischemic events (hypotension, cardiac events)
- Aflatoxin poisoning (chronic, severe, or acute)
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